Coronavirus exposes flaws with EU’s infectious disease agency – Thebritishjournal Reports

Coronavirus exposes flaws with EU’s infectious disease agency

Coronavirus was the crisis the EU’s infectious disease agency was built to tackle. It’s only served to illustrate its insignificance.

Though the virus has infected more than 3.8 million people in Europe, killed more than 190,000 and torpedoed the economy, European countries have struggled to coordinate a response. Panicking governments bickered over medical supplies, slapped each other with retaliatory quarantines and gave advice contradicting what their neighbors and even public health experts were saying.

For the European Centre for Disease Prevention and Control, 2020 was the year to put into practice 16 years of preparation as the agency designed to help harmonize Europe’s response to such a crisis.

But as the coronavirus overwhelmed the bloc, the agency could do very little.

The ECDC was born out of an inherent contradiction. Following the 2002 SARS outbreak, EU countries and the Commission realized they needed a more coordinated response to viral outbreaks. But they didn’t want an independent agency that could outrank them.

Their solution: To create an agency that has no power to coordinate.

With a limited mandate, budget and staff, the agency has spent its years as a little-known scientific body sandwiched between the Commission and EU capitals. It can’t be too pushy without antagonizing. It can’t be too visible without being accused of overstepping its mandate.

Interviews with former officials and politicians involved in the agency’s creation suggest the coronavirus crisis has brought to the fore limitations in its operations that were built into it by design.

The ECDC is “short of the powers that they really needed,” said John Bowis, who led the European Parliament during negotiations over the agency’s founding. “As a result, there’s an endemic weakness in [its] operation.”

When the coronavirus hit, the agency did issue scientific advice but often to little effect on EU capitals — and sometimes only after countries had made their own policy decisions. It held back from interpreting or explaining the data it gathered on grounds that such a move would exceed its remit. Unlike other international agencies, it never spoke directly to citizens.

As October brings rising case numbers and fears of a fresh coronavirus wave across Europe, scrutiny of the ECDC’s efforts to marshal a unified response from national capitals over the past eight months points to a dysfunctional arrangement only likely to persist.

“Our current role can only be to give guidance and present … some options for response,” ECDC Director Andrea Ammon told POLITICO in an interview. “But what [governments] then do in the end is their responsibility. And they are then, of course, also accountable for it,” she said.

Trial by fire

One of the few moments the ECDC was thrust into the spotlight proved to be a huge misstep.

In the Commission’s press room on February 27, an agency official reassured reporters that there was only a “low to moderate” chance that the coronavirus would spread across Europe. Moreover, governments had solid preparedness plans and adequate testing capacity. Europe would see small clusters, but the Continent would be able to contain them, the official said.

As journalists interrogated the assessment, referencing in particular the exploding case numbers in Italy, the official responded by saying there might indeed be more cases than the agency was aware of — but added that the coronavirus thus far had killed fewer people than the ordinary flu.

The caveat came in the equivalent of a verbal footnote: “We don’t know how far this will spread.”

It didn’t take long to find out. That weekend, cases in Italy spiked from around 200 to around 500 each day, then to thousands a day by March 8. Less than a week after the press briefing, on March 2, the agency changed course and said there was a “moderate to high” risk the virus would spread in the bloc.

Despite the questions it raised, some, including Zofija Mazej Kukovič, a Slovenian MEP who fills the Parliament’s spot on the ECDC Management Board, have pushed back against criticism of that particular incident. As she noted in comments in June, the agency made mistakes, but there were no “big visionaries” either inside or outside the agency who foresaw how the virus would spread.

The ECDC also clearly wasn’t sleeping on the job. It has produced 44 reports with public health advice relating to the crisis and updated its risk assessments 16 times since January.

But almost everyone agrees there’s a crucial problem: The agency has struggled to oversee fundamental disease surveillance because it has received poor data from countries. Reporting methods have differed among countries or within a single country, making it difficult for the agency to assess the virus’ impact in Europe.

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“We had huge delays at the beginning,” Ammon acknowledged in public comments in July. With different reporting methods, it was hard for the agency to interpret the data on hand: “Does the country have few cases because they have no transmission? Or because they don’t test?” she asked.

But critics also point to the agency’s reluctance to draw conclusions from its scientific analysis, and say the guidance it did offer was too technical to apply.

Charmaine Gauci, the head of Malta’s coronavirus response and a member of the agency’s advisory forum, described how, in late spring, she sought a list of countries that were safe for people to travel to. But when she checked with the ECDC, she found daily case numbers rather than information assessing and explaining the spread in certain areas.

She said she wished the ECDC would have been more “proactive rather than being reactive” in providing the information.

Similarly, a member of the ECDC’s Management Board who declined to be named for this article reported frustration at the agency’s reluctance to assess which third countries it would be safe for the EU to reopen at the start of the summer. According to the member’s retelling, the agency initially said it didn’t have enough information until countries pushed the agency to help.

“As a public health authority … we still have to be able to tell the public … you can go to Mexico, but you cannot go to Brazil yet,” the board member said. “I expected the ECDC to help us.”

But the agency is limited in how much it can help. After working on the third countries list, the ECDC was tasked with helping harmonize border restrictions within the EU. During twice-weekly meetings, EU countries told the agency they wanted maps showing the coronavirus situation across the bloc, which could help set harmonized quarantine measures and travel restrictions.

Meanwhile, these same countries bickered about how many maps they should have; debated the thresholds for so-called “red-zones”; and continued to insist, according to people present at the meetings, that they’d make their own health policy decisions.

The ECDC’s representative can’t do much more than sit and remind countries that scientific advice has never recommended border closures unless a country has next-to-no cases — advice that has been ignored since the beginning of the pandemic.

Another case in point: The Commission has continued to push for a test to replace the need to quarantine when traveling to another EU country — despite the ECDC’s counsel that such an option isn’t scientifically sound because the virus is difficult to detect during incubation.

The cost of indecision

The European Parliament originally wanted to create a powerful agency that covered all diseases — not just the infectious ones — and, crucially, could tell countries what to do.

But the Commission wanted the agency to function purely as a scientific body under Brussels’ control. Meanwhile, national governments — especially powerful ones such as the U.K. and Germany — didn’t want an EU agency that could overrule their national authorities.

The result was an agency created in the image of the U.S. Centers for Disease Control and Prevention (CDC), but with a budget dwarfed by its American counterpart. The ECDC’s budget — around €50 million each year — is much smaller than the CDC’s $12 billion. And although the ECDC’s staff has grown to nearly 300 people, it’s a fraction of the 10,000-plus CDC employees across the United States.

In hindsight, German Health Minister Jens Spahn said this spring, the ECDC is “really far, far away from the U.S. CDC,” in terms of what the European agency can do.

That hindsight came too late for some public health experts.

In 2012, Scott L. Greer, a public health professor at the University of Michigan, wrote that the European agency’s set-up meant that it “cannot give orders to anyone but its own staff.” Rather than becoming a “hub,” the agency risked becoming a “hollow core.”

The agency’s tasks, as laid out in its founding regulation, are to identify and assess risks, issue scientific opinions, provide technical assistance to countries and help with information sharing.

Its “tiny staff, its overlap with existing vertical policies, and its lack of executive powers made it look like a symbolic political entity rather than a threat,” Greer wrote.

Still, many former employees describe the ECDC’s early years as the “golden era.” Its well-liked first director, Zsuzsanna Jakab, tried to make the agency a “visible beacon” in Europe, according to Arnold Bosman, a public health consultant at Transmissible and a former ECDC employee.

Among her decisions, Jakab set up the agency in Stockholm in 2005 so that it would be more independent from Brussels. Jakab sometimes went directly to national officials to ask what they needed, rather than going through the Commission, which angered some in the Commission, according to former staffers. But it seemed to work: The agency’s staff and budget continued to grow each year.

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After the 2009 swine flu pandemic, the European Parliament came to the conclusion that the ECDC would benefit from more money to help countries coordinate. But this didn’t happen.

The ECDC’s budget, as many EU agencies, plateaued starting in 2010, despite inflation. Its ambitions were “scaled back,” according to a former employee who spoke anonymously. “Suddenly the possibilities were no longer limitless.”

For those inside the agency, the following decade was a low point. There was a sense that ambitions of becoming an international leader in public health were scaled back. After 2010, the criteria for approving travel outside the EU became a lot more restrictive. The agency also stopped advising health authorities on best practices because it was “non-core.” Some scientific work was outsourced.

After the agency’s second director Marc Sprenger resigned in 2015, the agency struggled to find a replacement. Its current director, Ammon, acted as interim chief until she became the official head in 2017.

Employees in that period — as detailed in a confidential external review from 2018 seen by POLITICO — said the mood switched from one of excitement to one of bullying and shouting.

Office space was also sub-par. When the Czech MEP Kateřina Konečná became the Parliament’s ECDC contact person in 2016, she said she was “horrified” to discover the agency’s building couldn’t house all of its employees. Looking back today, she says, she “cannot imagine how the agency [would have dealt] with this pandemic” in those conditions.

The agency moved into a larger building in 2018, but years of being an EU afterthought had left the agency timid, said Thibaud Deruelle, a researcher at the University of Exeter studying the ECDC.

“They are really wary of their reputation [and] of the image they project,” he said. “They don’t want to be portrayed as the people who decide anything.”

Doing it our way

In an interview in August, Ammon pushed back against some of these criticisms. She said, for example, it was “never in question” that the agency would help draw up a list of safe countries for travel outside the EU.

The question was how much information the agency would provide, as it struggled to assess the validity and reliability of data from other countries, she said, but the list was in use starting in July. The ECDC has since also helped draw up lists of maps designating “green” and “red” zones across the EU.

But some countries have not followed the third-country list anyway. And governments have not used the ECDC’s maps to harmonize travel restrictions, quarantine times or testing requirements within the EU’s own Schengen area. In this respect, Deruelle said, it may have been a smart move that the agency wasn’t too pushy as it knew it didn’t carry a big stick.

Ammon herself said the agency relies on good working relationships with national capitals, with the hope of being “super convincing” to get something specific done.

She also stressed there’s a limit to what the agency can do, in part because it relies so heavily on countries for information. If governments want the agency to provide more information, “we can do this,” Ammon said. “But you have to give us the data.”

Regardless, the agency has tried to improve, hiring 20 new staffers and making its guidance user-friendly by including infographics that are “easier to grasp,” Ammon said.

The agency has also increased its online presence and produced videos for the public on how to wear masks. Ammon appeared next to the EU’s Health Commissioner Stella Kyriakides for a press conference in September when the agency updated its risk assessment as cases spiked across the bloc.

Should the agency be more visible? Countries have specifically told the agency not to be, Ammon said. Should the ECDC be more forceful? Ammon said she’s doing this out of the public eye, and she thinks it’s working.

When asked if the agency’s approach indicates it’s more comfortable sticking to the science, Ammon paused. An otherwise silent aide blurted out: “It’s not a comfort zone. It’s a mandate.”

The next crisis

Calls for the agency to be reinforced are growing louder, including from Commission President Ursula von der Leyen in her State of the Union speech — but how it might change is very much up for debate.

The Commission is writing up a mandate change to unveil at the end of November. The European ombudsman is currently evaluating the ECDC’s handling of the coronavirus outbreak. Countries also want a report on the agency’s work, which could take years to produce.

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Several national and EU politicians have said the ECDC should get more money and hire more staff to deal better with the next pandemic. Germany’s Angela Merkel and France’s Emmanuel Macron have gone further, saying the agency should be more involved in coordinating countries’ responses to health emergencies.

But that might require major adjustments to the current legal and political arrangements.

Meanwhile, even getting a bigger budget could be difficult. Von der Leyen and others are moving to create an entirely new agency, similar to the U.S.’s Biomedical Advanced Research and Development Authority (BARDA), which was specifically designed to jump into action and fund procurement and research efforts when there’s an emergency. What this new agency would look like is still to be determined, but it too will require more EU money.

The former ECDC employee who spoke anonymously acknowledged that many of the big decisions made during the pandemic — notably shutting borders and implementing lockdowns — are just too political for the agency to make.

For her part, Malta’s Gauci opposed giving the agency this kind of power, on the grounds it would make a technical agency a political one: “It’s important to have a body [that] is talking pure science,” she said.

But others, such as Czech MEP Konečná, argued that if the ECDC is going to impact future crises — let alone the remainder of this one — then the “ECDC desperately needs these powers.”

The ECDC is by no means the only infectious disease agency being scrutinized right now. The World Health Organization has been called too political, too deferential to China, and ignorant of evolving science. The CDC has been criticized for being overly bureaucratic, reliant on old technology and allowing itself to be hijacked by politics.

Some say the ECDC should merely live up to its name, namely the “control” part. Currently, the ECDC is “the European Centre for Disease Prevention and risk assessment,” said Bosman, the public health consultant and former ECDC employee.

While Europe’s national experts, such as German virologist Christian Drosten or Belgian virologist Marc Van Ranst, frequently appeared in the press, officials from the ECDC have kept a low profile.

Some think the agency could use the ongoing pandemic as a chance to reinvent its role.

Bosman said it could take a page from the WHO, which has played an important role in disseminating information and coordinating countries during the pandemic.

“The WHO is actually stepping over this boundary [to] say, ‘Listen, it’s your responsibility; you’re the politicians, but don’t close your ears — this is what you need to do,’” Bosman said.

Countries are “not going to listen to you if you keep whispering,” he said.

David M. Herszenhorn, Sarah Wheaton and Hanne Cokelaere contributed to this article.

Coronavirus exposes flaws with EU’s infectious disease agency The British Journal Editors and Wire Services/ Politico.

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